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FOR-OFFICE USE: ---------- -------------------------------------------- - APPLICATION FOa r SANITATION PERMIT Permit No. ------------------------------ ---------- ---- - -- -- (Complete G ., � (Comlete in DuDate Issued This Permit Expires I Year From Date Issued Application is hereby made to the San Joaquin Local Health.District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. A JOB ADDRESS AND LOCATION__�_LIS_�_�2 _ _4�5 ----NQ.._6-R-AN�------------------------JA---1INT—C-A----------- Owner's Name----- -A'-'--p'_----- ------------------------------------- ------------------ --- --- ------ Phone------------------------------------ Address--------------71.1---------AQ-----•--6 A.NT-------------------MNTe ---------------------------••-----•--.-----------------------------•----------- Contractor's Name__e?_-•-- Ca9R61__I F=_ ....----•----------------------------------------------•-------------------------- --- ----- Phone----------------------------------- ---------- will serve: Residence ❑ Apartment House ❑` Commercial [:] Trailer Court E] Motel ❑ Other Number of living units: 3__ Number of bedrooms __E?--- Number of baths ?�- __ Lot size ----------------------------------------------------.----___ Water Supply: Public system ❑ Community system Private ❑ Depth to Water Table ;51-"ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ "Clay Loam [3 Clay ❑ Adobe(] Hardpan ❑ Previous Application Made: (if yes,date---.------- ] NojO'*-' New Construction: Yes ET""No ❑ FHA/VA: Yes ❑ No Er-- TYPE fTYPE OF INSTALLATION AND.SPECIFICATIONS: + Xaferial (No septic tank or cesspool permitted ifpublic sewer-isiavailable within 200 feet.)- Septic Tank: Distance from nearesf well_________________Distancefro1 foundation____.__-_______ _______.--_-_______-_____----_____-.____.__- I_�C1�jf4C— No. of compartments---------- -------- -----Size------------ L'u id de --------------------------Capacity Disposal Field: Distance from nearest-well---`--------Distance from foundation:._ -----------Distance to nearest lot line-----�----_. F_XVNTt HG- Number of lines-.-.,---./- fi,_ ._._.--------- __,t__Length of each line------- ..7"�______ Width of trench_,_______.__- - t�---� .------------ � d— ftDQ Type of filter material_. QCK---- ---Depth of filter material__;----��j__.____Total length----------75�- ------------------- Vy Seepage Pit: Distance to nearest well----------------------Distance from foundation------------------ to nearest lot line-__-.-----_. -. ❑ Number of pits------------ -- --Lining-material----------- Size: Diameter__,_____,.__.---------Depth------------____---_--------_.--• Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material___________________________._-___-_ ❑ Size: Diameter------------------------------------- Depth_r,------------------------------- -----------------Liquid Capacity_.------------------------gals. ❑ Distan to nearest st' line--------------------------------------- -Distance from nearest building.____________-___________________..___.._. Priv Distance from nearest welL_______x�______ :-. Y' � r ----------------------------------------------------- ------------------------- -------------------------------------------- �f I= t Remodeling and/or repairing ( escri e):- _____15-------FRs?M____-CMRRf ____ ov DRTt_Qt1C��_w____ ...N _____ `H 1= n t4sitt -------------- v;'41_t--h_i3-1.- -flv_D- �s--------hF �--�1Di ,�-- 0 ------C!'!_MC4_7�-`-----C1 T---- { � ►_ +L r p1V f}c-T _R 1�4T t --------- ------------- -------- ------------- -------------------------------------------------------------------------------------------------------------------- 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, S e laws, and rules an egulations of the San Joaquin Local Health District. ' .a {Signed)-- - -------- - ------------------r----------------------- =--------------------'------------------------------------(Owner and/or Contractor) ----- Title-------------------------- ---- ----------------- -------------- BY:----------------- -----------------) t - -0' (Title) (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). �' FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------�-- ,_R' ----------------------------------------------------------------------------------------------------------------------------------------- DATE------ - REVIEWEDBY---------------•---------------------------------------------- . DATE------------------------------------------------------------ BUILDING PERMIT ISSUED------------------------------------------------------------------ -- DATE-------------------- --------------------------------- ------------------------------------- -• Alterations and/or recommendations:------ ---------" ---------- ----- --- ----- --------------------------•-------------------•-----------•-- •------•-•--------•-•---------------------------- ------------------------------------------ ---------------------------------------------------------------- ---------------------------------------------------------------------------•--------- y FINAL INSPEC Date"-- .. ---- ---- ----------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E6 9 REVI%rb B-59 3M 3-'63 F.p.CG. M